'y'^-M»y: 



'^m\ 



OF AMERICA. V./.,:y^|^;y ^| 








ClassHi3^8M 
Book > P73 



PRESENTED BY 




'$M 



^^■^%^w. 






V 



MEMORANDA. 



MEMORANDA, 



1 



MEMORANDA. 



THE 



Prudential Insurance Company 



OF Rm^HlCR. 



iNFOf^MATION ^NC) SUGGESTION'S 



FOR 



ORDINARY BRANCH EXA/^INERS. 



1895. 






Gift 
f ' W, Putnam. 



PRE FAC E. 

This book of instructions is not a treatise on physical 
diagnosis. An Examiner's appointment presupposes his 
qualification in that branch of knowledge. 

It is made up of practical suggestions based on experi- 
ence at the desk in reviewing medical reports. 

It deals with some of the business aspects of life insur- 
ance in their relation to the work of the Examiner, as 
well as with matters purely medical. 

Read it Unless one is an exceptional Examiner, he 
will find in it suggestions that will enhance the value of 
his services and materially lighten his labor and our own 
as well. 

• EDWARD H. HAMILL, M. D., 

Medical Director. 



C0[4TE]SlTS. 



Age 

Alternate Examiners . 

xVmount of Insurance 

Blank Bill Forms 

Blindness ..... 

Deafness 

Exact Date of Birth 
Examination — where made 
Family History .... 

Fees 

Four Important Points . 
Habits . . . ... 

Habits, pernicious 
Height and Weight . 
Mark of Identification . 
Medical Examiner — qualifications of 
Medical Examiner — duties of 
Medical Report — 1st part 
Medical Report — 2nd part 
Medical Report — how disposed of 
Microscopical Examination of Urine 
Mileage. ..... 

Moral Hazard of a Risk . 
Occupations — undesirable . 
Occupations — hazardous 
Occupations — trade terms denoting 
Occupations — general terms denoting 

Pulse Rate 

Race . . . . . 

Rating the Risk . • . 

Revival Examinations . 

Rules for Examination of Females 

Signature of Applicant . 

Signature of Examiner 

The Medical Examiner's Insurance 

Urinalysis — Rules for 

Vaccination 



Decalogue 



16-1 



T[ 



IIlFOHlfflflTIOJi HUD SUGGESTIONS 

FOR 

ORDINARY BRANCH EXAMINERS 

OF 



A Medical Examiner for the Ordinary Branch Medical 
is regularly appointed as such by the Medical gf^^'^'Ip- 
Department of the Company. pointed. 

QUALIFICATIONS. 

1. An applicant for appointment shall present 
satisfactory evidence of his ability to discharge 
the duties of an Examiner. 

2. He shall be a resident and in active practice 
in the town or city for which the appointment is 
made. 

3. He shall be at least 26 years of age and Qualifications 
under 60 years. "'^^^ 

. 4. He must be in full possession of his faculties, 
especially those of hearing and sight. 

5. He must be in good repute with his pro- 
fessional brethren, of temperate habits, and of 
strict integrity. 

6. It is desirable that he shall have had five 
years, or more, of experience in the practice of 
his profession. 



APPOINTMENT. 

Appointment. Hc will rcceive official notice of his appoint, 
ment. 

The appointment having been made, the Medi- 
cal Examiner is entitled to and should receive 
all cases requiring examination. If there is 
more than one Examiner , a just distribution of 
the work should be made. 

He forfeits his appointment by failure to ex- 
amine promptly, repeated absences, incomplete 
and unsatisfactory reports, intemperance, or 
change of residence to another city or town. 

When an Alternate Examiner is appointed, he 
is expected to discharge the duties of the Regular 
Examiner only during the latter's absence, illness, 
or disability from any cause. 



Alternate 
Examiners. 



HIS RESPONSIBILITY. 

An Agent is directly interested in the result of 
every application he writes, inasmuch as a cer- 
tain amount of money is contingent upon the 
acceptance of the risk. The Company is in like 
manner directly interested because an obligation 
to pay a certain amount is incurred with the issue 
Responsibility of cach Dolicy. The Medical Examiner alone is 

of an . 

Examiner. Hot financially interested m the result. He re- 
ceives his fee whether an applicant is accepted 
or declined. His advice is paid for in every case. 
If it is unwisely given, and a safe risk is declined 
because he has reported it unsafe, the Company 
sufiers from loss of business. If, on the other 
hand, an unsafe risk is accepted because of in- 
judicious advice, the Company is subjected to a 
loss that should have been foreseen. In both 



of the 
Company. 



instances, i. e., If a safe risk is declined or an 
unsafe risk taken, the Company suffers. 

It is the function of the Examiner to conserve 
the interests of the Company he represents. He 
should not be influenced by the importunities of 
an Agent or the appeals of an applicant. For 
the time being, he is the custodian of the Com- ^is work is m 

*-' ^ the interest 

pany's interests. There could scarcely be a more 
important duty than the one he is called upon to 
perform. Nothing in the history of a case should 
be concealed. His report and his advice should 
be clear, complete^ concise; definite and abso- 
lutely truthful. 

DUTIES. 

He should read the medical blank carefully and 
acquaint himself with its arrangement and the 
intent of each question. 

He should carefully read the Medical Instruc- 
tion Book and the Xotes on the Moral Hazard 
of a Risk and be guided by the suggestions con- 
tained therein. 

He must be prompt in the discharge of his 
duties. 

He should hold himself in readiness to call 

. Expected 

upon applicants at their homes. He cannot ex- to cau upon 
pect parties applying for insurance to call upon -^^'^^^^^ 
him ; neither should he require it. 

His examinations should be made in a quiet 
place. A shop where business is transacted, or 
a business house of any description, is not the 
proper place. 

Examinations should not be hurriedly made. 

His reports should always be written with ink. 



Examiner's 
Duties. 



Read 

Instruction 

Book. 



He should replj^ promptly to all communica- 
tions from the Home Office. 

Each question and each subdivision of a ques- 
tion should be accurately answered. Ditto marks 
are not regarded as answers. 
A personal A caTcful pcrsoual examination must be made 

Examination . 

necessary, lu cach casc ou thc date named on the report. 

The signature of the party examined must, in 
every instance, be secured by the Examiner at the 
date of the examination. 

MEDICAL REPORT. 

No less than eleven questions are to be found 
on the medical blank concerning the occupation 
of the applicant. Especial attention should there- 
fore be given to this point. All the questions 
should be asked and the answers carefully noted. 
o/deterS^g If ^ general term is used to denote an occupa- 
occupation. ^^^^? ^^^^ ^^ clcrk, salcsman, mechanic, driver, 
teamster, cooper, etc., the line of business in 
which the applicant is engaged should invariably 
be stated. 

When technical terms are used, such as rougher, 

presser, cutter, roller, kilnman, electrician, or 

Explain ^^^y other term that designates the duties of the 

Trade Terms, party, he should invariably explain exactly what 

such duties are. 

Persons engaged in the following occupations 
are not regarded as desirable risks : 

Barkeeper, 

Beer-bottler, 

Blastino' 



Brewer (except tliose employed in office or 
owning the business), Forbidden 

Cartridge-maker, occupations. 

Cotton Factory Operatives (unless foreman or 
superintendent), 

Electric Light or Telephone Lineman, 

File-finisher, 

File-grinder, 

Glass-blower, 

Glass-gatherer, 

Grain Elevator Employee, 

Grinder of Edge Tools, 

Handler or Maker of Explosives, 

Horse-trainer, 

Laborer — Common, 

Liquor Dealer — Retail, 

Lumberman in woods. Forbidden 

Miner (except foreman or superintendent), occupations, 

\ ^ ^ '' continued. 

Quarryman, 

Raftsman, 

Sailor — Common, 

Saloon-keeper, 

Sawyer — Knott, 

Section Hand R. R., 

Submarine Operations, 

Smelter, 

Turkish Bath Employee, 

Telephone Inspector, 

Target-man, 

Well-digger, 

Wrecking Train Laborer, 

Zinc Works Employee. 

There are certain occupations more or less 
hazardous because of the liability to accident or 
disease. This increased hazard is compensated Hazardous 

Occupations. 

for by an increased premium. Below, we give a 
partial list of these occupations. An extra pre- 
mium is charged all persons so engaged. The 



Occupations 
involving 

an Extra 
premium. 



Occupations 
involving 
an Extra 
pixmium, 
continued. 



Habits of an 
Applicant. 



Company reserves the right to alter or amend the 
lists at its own discretion. 

Baseball-player^ 

Bridge Builder (large iron structures), 

Engineer or Officer of lake or sea vessels (first- 
class passenger vessels, no extra), 

Electric Light Trimmer, 

Electric Light Employees handling live wires, 

Engineer or Fireman of Stationary Engine be- 
low level of ground, 

Fisherman — Sea (in bays and inlets, no extra). 

Foreman or Superintendent of Mine, under- 
ground. 

File-finisher, 

Iron-Avorkers (subject to extremes of heat), 

Polishers (using emery wheel), 

Stone-cutter, 

Sawyer — Buzz, 

Sawyer — Circular, 
Railroad Employees — 

Brakeman — freight, coal or mixed. 

Conductor of freight. 

Conductor of coal or mixed, 

Engineer of Locomotive, 

Fireman, 

Switchman, 

Coupler, 

Yardmaster — active (Supervising Yardmaster, 
no extra). 

Yardman. 

The most perplexing questions to be answered, 
and probably the most important, are those relat- 
ing to the USE OF INTOXICANTS. It should be re- 
membered that an excessive drinker will rarely 
admit the fact. 

The denial of excess may be made innocently, 
the party not knowing that the amount consumed 



intemperate 
habits. 



is excessirc. AVhen this is the case, the average 
quantity used daily of malt liquors, wines and 
spirits will determine the point. If there is in- 
tention to deceive, no reliance can be placed 
upon statements made bv an applicant. 

As a rule, the Examiner should trust largely 
to the appearance of the individual. A m<:)ist, 
trembling tongue, flushed face, suffused eyes, and 
uncertain, nervous movements, usually indicate how to detect 
free indulgence. Shifting occupation or place of 
employment, unclean, neglected apartments and 
untidy appearance help to confirm the impression. 

If a suspicion exists in the mind of the Exam- 
iner, he should by all means call attention to it. 

Be careful to state the kind of drink habitually 
used. 

Remember that certain classes are especially 
prone to over-indulgence — printers, hatters, 
plumbers, tailors, teamsters, moulders, and those 
who are closely confined for long intervals and 
who work in ill-ventilated or overheated rooms 
are apt to seek relief fi^om the exhausting char- 
acter of their work by the use of stimulants. 

If a history of excessive use of intoxicants is 
given, exact details should be stated — when the 
habit was formed, how long it was continued, the ^^^^'^'^^"^^ 
period of time that has elapsed since the habit 
was discontinired. the apparent efiect upon the 
health, and the present limit of indulgence. 

When a severe injury or illxess is shown in 
the past history of the applicant, full information 
should be given as to the date of occurrence, kind 
of injury or illness, duration of the disaltility aris- 
ing therefi'om. number of attacks, etc. 



Classes 

tliat 

over-indxilg'e. 



Injury or past 
Dlness, 



In ascertaining the family history, care 
should be exercised to get at the facts. Appli- 
cants sometimes wish to deceive as to the causes 
of death of certain members- of the immediate 
Famny History, family. Dq not acccpt ^ ^ dou't kuow " as a cause 
of death unless 3'ou absolutelj' fail to elicit any 
information whatever. There are cases where 
an applicant cannot state the exact cause of death 
of some member of his immediate family, but 
where the Examiner can obtain a more or less 

Cause of Death • c* 

to be complete history of the last illness which will 
clearly stated, gij^-^^^^^^tc aiiy hereditary tendency, or prove the 
contrary. If enquiry has been made and nothing 
ascertained, enter in the space devoted to re- 
marks that such is the case. 

Indefinite expressions, such as grief, decline, 
marasmus, chUdbirthj shock, etc., etc., as causes 
of death give no information at all. Avoid them. 
If obliged to use them, do not fail to state that 
rigid enquiry reveals nothing. 

Note also that the Company desires to know 
not only the causes of death in the immediate 
family, but the duration of the last illness and the 
ages at death. 

If an applicant is under 30 years of age, and it 
is discovered that one of his parents died of con- 
sumption, this being the only death in the immedi- 
ate family, it should be the aim of the Examiner to 
Takir^^HmTto fii^d out if that parentis family history is clear of 
^^ ''''*• a tubercular taint. If it is the applicant's father, 
he should enquire regarding the causes of death 
and the ages at death of the paternal grand- 
parents, uncles and aunts ; if the mother, the 



9 

enquiry should be directed to the maternal grand- 
parents, uncles and aunts. 

Get the full signature of the applicant. As the 
Examiner does not see the application, he should 
request the General Agent to give him the name 
of the party to be examined Just as it luas signed 
on the application, signature 

of Applicant. 

He should witness the signature himself. This 
duty cannot be deputized to another. 

A traced or pencilled signature will not be re- 
ceiyed. 

The medical blank contains two subdiyisions or 
parts. One of these subdiyisions is used to 
record the statements made hy the applicant to 
the Company through its Medical Examiner. 
The other is used to record the statements made 
Jjy the Examiner directly to the Company. The 
first part is officially entitled, ^^Declarations 
made by the Applicant to the Medical Examiner." Medicai Blank, 
This is incorporated in the policy as a part of ^p^- 
the contract between the Insured and the Com- 
pany. The last subdiyision is called ^^The 
Medical Examiner's Report," and is a statement 
of the present condition of the applicant and the 
desirability of the risk, founded upon obseryation, 
acquaintanceship, more or less knowledge of his 
mode of life, the character of his occupation — 
whether healthful, hazardous or injurious to 
health — and a physical examination. 

The first part of the medical blank haA'ing been 
completed in accordance with the suggestions Medical Blank, 
off'ered aboye, the signature of the applicant 2nd part, 
secured and witnessed, we turn to the last sub- 



10 

division of the blank, or that part entitled ^ ^ The 
Medical Examiner's Report. " Especial attention 
is requested to certain questions to be found 
thereon. 

^^ Where teas this examination made .^'' 
It is desirable to know whether the Examiner 
has had the opportunity of seeing the home of 
Place where \x^q applicant, how hc lives, the comforts with 

Examined. j. x 7 7 

which he is surrounded, the character of the 
locality, etc. The examination at the home is 
desirable, too, because of the freedom from inter- 
ruption and from noise, and the greater willing- 
ness of the applicant to remove his clothing. At 
the house, one can ascertain if the party is mar- 
ried and has children, and that the correct address 
has been given. It will also be more difficult to 
substitute some other person to pass an exami- 

Advantage of natlou, lustcad of the applicant himself When- 
Home ... , , , . , 
Examination, cvcr thc cxamiuation IS made at the applicant s 

home, question 34 should be answered, '^ At 
applicant's home." 

While there is no serious objection to an exami- 
nation at the agency office, or at the Medical Ex- 
aminer's rooms, provided a quiet place can be 
secured, the Examiner must remember that it is 
easier to practice fraud away from the residence 
of the applicant. He should, whenever he makes 
a report upon the life of a stranger, take means 
to verify the occupation and establish the iden- 
tity of the person examined. 
T\Tien It is vcry easy for a barkeeper, for instance, to 

Examined, rcprcscnt hiuisclf as a drygoods clerk or sales- 
man, and if statements are taken as sole author- 



How to state 

place of 
ExaminSHion. 



u 

itv for occupations^ we fear that in some instances 
the Examiner will be deceived. 

Examine at the home when possible. If else- 
where, state just where, as for instance, ^^ at my 
office, " ^ ^ at agency office, " ^ ^ at a friend's house, '' 
^ ^ in a quiet room in rear of office or place of busi- 
ness," etc. In every instance verify the home 
address of the applicant and the occupation by 
using a city directory or taking any means your 
judgment may sanction. 

These precautions are important and we hope 
will be closely observed. 

'^ Do you believe that he or she has truthfully 
ansivered all questions on the other side of this 
sheet ?'' 

This question affords an opportunity for the 
Examiner to call attention to misstatements made 
by an applicant. If, for instance, he is a bar- 
keeper and has represented himself as a clerk — Appucant. 
if he has the appearance of an intemperate per- 
son and has denied over-indulgence — if he is an 
opium eater and has stated that he did not use 
the drug — if he has denied the existence of a dis- 
ease and it is known to the Examiner that such 
representation is false, the question should be 
answered ^^No" and full information given in 
the blank space for remarks. 

VACCINATION. 

Has he (or she) been successfully vaccinated ? 
Do not take statement on other side without ^^''s^r*'°'' 
confirmation. Look for the scar. 



Truthfulness 
of an 



BODILY MARK. 

Bodii Mark ^^ ^^^^ ^^ rccord any bodily mark, as this may 
prove valuable as a means of identification after 
death. 

Three questions relating to occupation appear 
on the last half of the medical blank. They 
should receive careful and thoughtful attention. 
The Examiner should describe the nature of the 
duties discharged by the applicant. This is par- 
Expiain ^ Duties ^j^^l^^.^^ obHgatory if a trade term is used to 

Occupation. (Jeuotc thc occupatiou. The character of the 
surroundings, the tools used, the atmosphere and 
temperature of the workshop, the danger of 
systemic poisoning, the quantity of dust in the 
air, the diseases to which the workers are espe- 
cially predisposed and the liability to accident 
should be thoroughlv understood and described. 



RACE. 

This question should be answered always, 
^' White " or '' Colored." There can be no objec- 
tion to adding the nationality, as, for instance. 
White (Spanish), Colored (U. S.), etc. 

SIGHT. 

Blindness in one eye is not regarded. Total 
blindness, everything else being desirable, im- 
poses an extra premium. 

HEARING. 

Any defect of hearing should lead to enquiry 
for a history of otorrhoea. If such exists, or has 
existed, full particulars should be given. The 
date of its occurrence, the cause, the length of 



13 

time it continued, Avhcther pnrulent, bloody or 
offensive, and whether periodical or continuous 
should be ascertained and noted. 

In every medical report upon a life, four 
pomts of paramount importance are to be con- 
sidered. They are : 

The Occupation, 

The Habits, 

The Age, Four Points oi 

The Physical Condition. importance. 

While the family history, the past personal his- 
tory, and the environment of an applicant cannot 
be disregarded, it is still true that the four points 
above are of the greatest importance. 

We have already briefly considered the occu- 
pation and habits. Our attention is now called 
to the Age. This is a matter of dollars and cents 
— of increased liability and higher mortality. If 
an age is incorrectly stated, somebody suffers 
unjustly. If an applicant is younger than the 
age at which he was insured, he is deprived of 
the increased amount to which his premium en- 
titles him at his true age. 

If, on the contrary, he is older than the age at 
which he was insured, the Company insuring him 
is liable for a larger amount than would have 
been the case had his age been correctly given, 
the premium remaining the same. Let us illus- 
trate : 

The Prudential's rate for a Whole Life Policy 
of $1,000, at age 30, is $22.63 ; at age 31 the rate 

„^^^ . n ^^ , ' • r» Importance of 

IS $23.32, an increase oi 69 cents m premium for Exact Age. 
au advance of one year in age. This difference 



Aga 



14 



Age continued. 



in premium (69 cents) of which the Company is 
deprived by a misstatement of age, is equivalent 
to $30 of insurance at age 31. 

Should 1,000 persons state' their ages at 30 
when in reality they are 31 years of age, the 
Company would be exposed unjustly to an in- 
creased loss of $30,000. Several thousand per- 
sons are insured each year. From a financial 
point of view alone, it will be seen at once that 
the question of age is of great importance. 

While we recognize the difficulty in ascertain- 
ing an exact age if the applicant desires to 
deceive, it should be the aim of an Examiner to 
carefully enquire into the matter, and if he has 
doubts of the correctness of the age given, he 
should by all means call attention to this question 
and give his opinion in unmistakable terms. 

We would suggest that before the Examiner 
asks an applicant for his age, he determine in 
his own mind what that age is. If he pursues 
this course he will find his power of observation 
Exact Age. bccommg gradually sharpened, and he will, after 
practice, become expert in detecting the differ- 
ence, should any exist, between the age given by 
an applicant and the apparent age. In short, be 
rigidly observant and alive to the importance of 
this one point. 

Be sure the exact day, month and year of birth 
is given. We shall compare the Examiner's 
statement with the same item on the application. 
If they disagree the error should not be charged 
to the Medical Examiner, 



How to find 



Exact 
Date of Biith. 



15 

HEIGHT AND WEIGHT. 

Wc give below the maximum and minimum 
weight for a given height. If the weight as 
stated by the applicant is above or below the Maximum and 
limit here given, the figures should be verified by Mmimmn 

^ ' ^ ^ Weight. 

actual weight and measurement. It should also 
be ascertained if the disproportion is an indi- 
vidual or family trait. Underweight in persons 
above 40 years of age, is especially significant. 

Max. Min. 

4 feet 10 inches 150 83 

4 '^ 11 '' 160 87 

5 ^' 167 92 

5 ^^ 1 '' 174 96 

5 '^ 2 '' 181 100 

5 ^^ 3 " 188 104 

5 ^^ 4 "• 195 108 Vexy rarely 

^ ii 5 U 200 112 Exceptions are 

5 ^^ 6 "' 205 115 ^ ^'^^ *abie. 

5 ^^ 7 ^^ 210 120 

5 ^^ 8 '^ 215 125 

5 ^^ 9 ^^ 220 130 

5 ^^ 10 '^ 225 135 

5 '' 11 '' 230 140 

6 '^ ..235 145 

6 ^^ 1 '' 240 150 

6 ^^ 2 '' 245 155 

6 ^^ 3 '' 250 160 

PULSE RATE. 

This should be taken at the wrist. Do not 
attempt to get the pulse rate while listening to 
the heart, for the reason that your attention will ^*eof puise. 
be directed from the main object in view while 



16 

auscultating that organ, namely, the presence of 
adventitious sounds. It is well to take the pulse 
before commencing the physical examination and 
after it is finished. The excitement incident to 
an examination will in certain persons cause an 
increased rapidity of heart action. The double 
When to take obscrvatiou recommended above will, perhaps, 
demonstrate that fact. If irregularity is noticed, 
do not be satisfied until the cause has been 
learned. An intermittent pulse is sometimes 
constitutional, and in a young and healthy indi- 
vidual may at times be disregarded. Always 
state the fact, and the relative frequency of inter- 
mission. Undue rapidity — over ninety beats per 
minute — will delay the case for further observa- 
tion. 

URINALYSIS. 

A chemical examination of the urine is required 
Urinalysis iu cvcry casc, and the following suggestions are 
always leqxiiied ^g^^j-g^j ^g r^ gnidc lu this vcry important pro- 
cedure : 

First — Be sure that the urine examined is 
voided by the applicant 

Seconcl — The specimen examined should be 
voided at the time of examination and preferably 
in the Examiner's presence. It is not wise to 
accept specimens brought or sent to you, and you 
should, in every instance, be able to certify that 
you are sure i\\Q specimen examined is genuine. 

Third — Examine within twenty-four hours after 
voiding, 
u^a^.;! Fourth-Observe : 

Qeneral appearance and color, If turbid, note 



17 

the fact, and state, if possible, the cause. Turbid 
urine should be filtered before chemical tests are 
applied. 

Specific Gravity. The specific gravity varies 
largely with many conditions. According to the 
standard set b}^ this office, it should not be below 
1010 or above 1030. If the specimen examined Rules for 
is found to be either side of these limits, and other ^^^^y^^^ con^ 

' tinned 

conditions are satisfactory, a second specimen 
should be examined before report is submitted, 
the result of both examinations being stated and 
also the probable cause of the abnormal specific 
gravity first observed. 

Reaction. Should the specimen be alkaline in 
reaction, acidulate with a drop or two of acetic 
acid before applying the test for albumen. 

Fifth — Examine for albumen, using the ordi- 
nary heat and nitric acid test or the cold contact 
test (Heller's). In applying the first use a good- 
sized test tube, filling it about three-fourths full 
of the urine and, holding the tube at the bottom 
slightly inclined, boil thoroughly the upper ^bumen. 
stratum. After boiling, hold the tube against a 
black background placed in a strong light and 
observe any diflTerence in the lower and upper 
strata. Should there be any cloudiness in the 
upper or boiled stratum which is not completely 
dissipated by the addition of a drop of nitric 
acid, it will indicate the presence of albumen. 

The cold contact, or Heller test, is applied as 
follows : In a perfectly clean test tube pour jj^^gj. ^est. 
about an inch of nitric acid, C. P., and then with 
a pipette trickle slowly down the sides of the 



18 

tube an equal quantity of the urine, floating it 

upon the top of the acid. Should albumen be 

present, a distinct white zone will appear at the 

point of contact of the two fluids, varying in 

thickness with the percentage of albumen present. 

Sixth — Examine for sugar. Do this in every 

case, regardless of the specific gravity. Fehl- 

Ruiesfor ii^g's tcst for sugar is sufficiently delicate for our 

Urinalysis con- purposc, aud wc rccommend the use of this test 

tinned. x x 7 

as prepared by Dr. E. R. Squibb. Full direc- 
tions for its use accompany each box. 

Seventh — When for any apparent or suspected 

abnormality it is necessary to make a second 

neTi^ry urlualysls, make it a point to examine a specimen 

to make second yQi(jQ(j (juring tlic pcrlod of actlvc digestion, as 

Urinalysis, . o ? 

abnormal constituents will frequently be present 
at this time and absent during the intervals. 

It is now universally recognized that both albu- 
minuria and glycosuria are frequently transient 
conditions and not indicative of any pathological 
condition. It is the custom of this office, in cer- 
tain classes of cases where albuminuria or glyco- 
suria is reported, the age and every other feature 
of the case being perfectly satisfactory, to order 
additional urinalyses, with a view of determining 
whether the condition recorded is permanent or 
temporary. No additional fee is allowed by the 
Company for these urinalyses, compensation for 
which must be arranged for either with the appli- 
cant or the General Agent. A Microscopical 
Examination of the urine is required when the 
sum applied for reaches or exceeds $15,000, and 
in sums below this amount if specially ordered by 
the Home Office. 



Albumen and 
Sugar. 



19 
RATING THE RISK. 

Having completed the Medical Examination 
and Urinalysis, the Examiner is in position to 
give the Company his judgment as to the desir- 
ability of the risk. This should be given after a 
careful consideration of all the points in the case. 
It is strongly urged that the Examiner before Rating the risk, 
rating the risk should read through his entire ^^^^^^^^^• 
report. Such a review will enable him to com- 
plete any omissions or correct any errors he may 
have made. After duly weighing the evidence, 
he should record his rating, using preferably the 
words given in the question, i. e., First Class, 
Fair Average or Poor. 

His report when completed should be forwarded 
by the Examiner directly to the Home Office. 
He should permit no one to review its contents, ^ExT^er\o^ 
and he should not sign report unless he has per- ^^"^^ ^®^^- 
sonally made the examination. An examination 
by proxy is not permissible. 

IF APPLICANT IS A WOMAN. 

While the Company issues policies upon the 
lives of women, it should be distinctly understood 
that this is done with certain restrictions, as fol- 
lows : 

1st. A married woman is not accepted unless 
her husband is already insured in The Prudential te^el^ 
or applies at the same time with his wife. 

2nd. A widow having one or more children 
who are self-supporting will not be accepted 
unless at least one child (preferably a son) is 
insured or applies at the same time, making his 
mother the beneficiary. 



20 

3rd. A single woman is required to give satis- 
factory reasons why insurance is sought and to 
show occupation and condition of health of father, 
if living. 

4th. Policies upon the lives of women are 
issued 

At ages 20-22 — 10-15 Year Endowment. 
At ages 23-24—10, 15, 20 Year Endowment and 

10 Payment Life. 
At age 25 — any form of insurance. 
Rules 5th. An extra premium is charged until after 

for females con- ., ,. .. .t I'li ^ !•. '-, 

tinued. the climacteric period, which has been arbitrarily 
fixed at age 50. 

6th. The limit of insurance upon the life of a 
woman is $2,500. 

Exceptions to rules 4 and 5 are sometimes made 
in the case of married women. 

It will be seen by the above that the Examiner 
is to ascertain. 

If the applicant is a married luoman — 
wi, ^ * ^ f Is her husband insured in The Prudential ? 

Wnat to do if 

married. Is hc iusurablc ? 

Does he apply with his wife ? 
If a single wormian — 

Is father living, in good health, and able to 
care for his daughter ? 

Is she (the applicant) self-supporting ? 
If smgie. Why does she desire insurance ? 

Who pays the premium ? 

Is any one dependent upon her for support ? 

Relationship, age, etc., of the dependent one ? 
If a ividoiv — 

If a widow. Has she children who are dependent upon her 
— if yes, their ages ? 



21 



FEES. 

The fee for a complete medical report varies, 
within certain limits, with the amount of insur- 
ance applied for. The following schedule has 
been fixed by the Company : 

If the amount applied for is less than $1,000 
—$2,00. 

If the amount applied for is $1,000 and less ^^Re^rL.^ 
than $5,000— $3.00. 

If the amount applied for is $5,000 or more 
—$5.00. 

For a microscopical examination, to be made 
when sum applied for is $15,000 or more, or in 
cases especially ordered by the Medical Depart- 
ment, an additional fee of $3.00. 

Medical Examiners' bills will be paid during 
the first ten days of each quarter, commencing 
January, April, July and October. 

Blank billheads will be provided by the Com- 
pany and should be used. They may be obtained 
of any General Agent or directly from the Home 
Office. All bills should be forwarded on or before 
the first day of the months above mentioned. 

In certain cases, and for good reasons, special 
arrangements may be made for monthly payment 
of bills. 

No allowance will be made for incidental expen- 
ses or for mileage. 

The fee for a medical examination for the re- 
vival of a lapsed policy must be paid by the per- 
son applying for such revival. The Company is 
not responsible for such payment. 



When paid. 



Revivals. 



22 



DHCflliOGUH. 



(03rciiraa.2rj7- "Rra-rac^lg. ) 



I. CarefulK read the Medical Examiner's Instruction 
Book. 

II. Examine promptly in a quiet place^ preferably at the 
home of the applicant, and allow no one to be present dur- 
ing your examination. 

III. Answer each qnestion and each subdiyision of a 
question. Be explicit in your answers. Ayoid indefinite 
expressions such as childbirth, shock, grief, accident, injury, 
change of life, don't know, etc. Use ink in writing. 

TV, Pay especial attention to the ayerage quantity of 
spirits, wines and malt liquors used daily. Giye an ayer- 
age of each. If there is a history of preyious excess, giye 
full particulars. 

V. Giye a full description of any illness in the history 
of an applicant — number of attacks — when last — duration 
and seyerity. 

YL Describe the duties of the applicant. Explain 
trade terms used to denote an occupation. . State the line of 
business or work. Note if occupation is hazardous or injuri- 
ous to health, and see that the true occupation is stated. 

YII. Giye careful attention to the Moral Hazard of the 
risk. 

YIII. Be sure the urine you examine was yoided by the 
applicant. 

IX. Be sure you examine the right person, and that you 
get the exact age, date of birth, and a full family history. 

X. Personally examine and personally secure and wit- 
ness the signature of the applicant. 



THE MOHALi HAZARD OF ^ HISK- 



In estimating the financial value of a risk^ an Insurance 
-Company is obliged to take into consideration other things 
than the jfresent physical condition. It does not give a 
true or correct idea to say of a man that he is a perfectly 
health}^ subject with a good family history and an excep- 
tional personal record in so far as health is concerned, and 
that therefore he is entitled to just such insurance as he 
desires. Unimpaired health, with all that can be desired 
in the way of freedom from disease since birth and a long- 
lived ancestry without taint of inherited malady, is not 
alone sufficient. Something more must be considered. 
There is a hazard in other directions which should be 
clearly understood before a risk is received. 

What is this hazard, and how shall we recognize it so as 
to conform with the usages and rules of the various Com- 
panies, especially our own ? We must give it a name. 
For want of a better one, we will call it the Moral Hazard. 
This term should not be understood as applying strictly to 
the morals of the individual — it is used to designate the 
greater or less risk incident to circumstances and surround- 
ings which may vitiate the true function of life insurance, 
or which may have an important bearing upon the life 
expectancy. It is impossible to separate clearly this moral 



24 

hazard from what wc may be allowed to call the phj^sical 
hazard of each healthy life. The two are mutually depend- 
ent, and it is for this very reason that the former is neces- 
sarily considered in conjunction with tlie latter before a 
decision can be reached. 

First. Let it be remembered that it is the function of 
Life Insurance to afford protection — that speculation in or 
upon the life of another is a perversion of this function. 
Any effort, therefore, to secure insurance upon a life with 
the hope of ultimate gain, introduces a vitiating element. 
The child who provides for the parent — the husband who 
supports the wife — can hardly seek insurance on the life of 
parent or wife under the plea of protection, for the simple 
reason that in each case it is the protected who seek insur- 
ance, rather than the protectors^ who ought to apply. For 
the same reason, A has no right to insure his life in favor 
of B, unless B is dependent upon A, or unless he is A's 
creditor. 

When, therefore, insurance is sought outside of the pale 
of protection, or without the intent to discharge an honest 
obligation, it ceases to be insurance and degenerates into 
speculation. This rule applies particularly to Old Line 
Companies. It does not apply to Industrial Insurance, 
except in rare instances, and for this reason : The labor- 
ing man who provides for his family, may, at any time, be 
called upon to meet unusual demands created by the sick- 
ness and death of his child, for instance. If he meets 
these demands without recourse to any other source, he 
will find himself burdened with debt, and his family de- 
prived of needed food and raiment until the necessary ex- 
penses attendant upon the illness and death of his child 
shall have been paid. To provide against this emergency, 
and to protect himself and family against an onerous 



25 

draught upon his income, he rightfully appeals to Indus- 
trial Insurance, which has been provided for this very 
})urpose. It does not matter whether it is his wife, his 
cliild, his parent, or his friend, provided the burden of the 
emergency falls upon him. For this reason, risks that are 
not acceptable in the Ordinary Branch are referred to the 
Industrial Branch. 

Second. The amount of insurance sought sometimes 
introduces a disturbing factor in the problem. It is well 
enough, perhaps, for the merchant whose daily transactions 
involve large amounts, to carry policies aggregating a 
hundred thousand or half a million dollars, but there 
remains, nevertheless, a normal proportion between the 
annual income and the amount of insurance to be placed 
on a life, or between the weekly or monthly wages and the 
size of the premiums. Just where the line should be 
drawn, we cannot say, except from a study of each case in 
all its bearings. 

One great Company issues the following to its Medical 
Examiners : ^^ A point upon which the Society has to look 
to its Medical Examiners for protection is that of the 
honesty of purpose of the applicant. The Examiner, there- 
fore, should take into consideration the relation between 
the amount of the proposed insurance and the probable 
means of the applicant, and if any undue disproportion 
appears, to enquire the reason for the present proposal, 
and set forth the same in his report." 

Third. Stability of employment — permanency of occu- 
pation is also to be considered. Many a man has ended 
his days in desperation because of his failure to regain 
employment which he has forfeited by misconduct. If it 
can be shown that one has been employed for years in the 
same place, and at the same trade, it will indicate at once 



26 

that his conduct has not been prejudicial to his employer's 
interests, or his own. The risk on such a life, is, of course, 
more desirable than when the conditions are reversed. 

Fourth. The possession of a home of his own has a sig- 
nificance in the case of every applicant for insurance. 
Nothing so develops a man as this fact. It is an anchor- 
age for him and may hold him safe from the current of dis- 
sipation where other influences would fail. Especiall^^- is 
this true if his home has been earned by toil and thrift. 
It is almost as well if he has been a continuous tenant for 
years. 

Fifth. Habits of gambling are especially pernicious, 
owing to the great nervous strain and intense excitement 
incident to such a life, with the periods of depression con- 
sequent on losses so great, sometimes, as to lead to suicide. 

Sixth. Influences that arise from occupations that, in 
themselves, are not hazardous, require careful attention. 
Some of the finest specimens of physical manhood to be 
found to-day are barkeepers ; men who are strictly temper- 
ate and who are faultless as insurance risks in all except 
the fact that the influences about them are constantly 
exerted in an injurious direction. The same remark applies 
to teamsters, printers, hatters, and other trades where long 
hours, little relaxation, and weariness of body are extremely 
apt to lead to over indulgence in strong drink. 

Seventh. The inability of an applicant to write his 
name at once attracts notice. If he is of native birth, his 
ignorance is almost inexcusable. If of foreign birth, the 
case is in no way improved. Such a man cannot under- 
stand the terms of a contract. He is easily deceived and 
must trust solely to verbal representations. He is not 
ambitious, and his consent to remain in ignorance of one of 
the necessary requirements of every citizen reflects upon 



27 

himself to his own disadvantage. His statements concern- 
ing his family history cannot be received with the con- 
fidence given to one who is educated. Furthermore, he is 
unfamiliar with hygienic laws, he cannot be identified by 
his signature, and he is, in all probability, engaged in 
unskilled manual labor with the wages usually paid for this 
kind of work. 

Eighth. As a rule, women should receive the benefits of 
insurance. They are properly classed with minor children 
as belonging to the dependent members of a family. It is 
not expected that they shall be the providers. This is the 
duty and the privilege of the stronger sex. When to this 
is added the fact that certain diseases peculiar to the sex 
are difficult to detect, the Examiner being placed at a dis- 
advantage in ascertaining their existence, it will be seen 
at once that female lives are not desirable risks. The 
experience of all Insurance Companies proves that this 
view is correct. It is, however, possible, and occasionally 
it is necessary, that the wife or daughter should make pro- 
vision for those who look to her for support. This can 
only occur because of the death or ill health of the male 
members of the family. When this necessity arises, it is 
only just that it should be recognized by granting insur- 
ance to those who desire it. Women should then have 
equal rights with men, whose duty, for the time being, they 
are obliged to perform. Unless this condition exists, a 
woman in applying for insurance usurps the prerogative of 
the man. 

There is still another reason why she may be insured for 
another's benefit. Sometimes the husband may wish to be 
joined by the wife in his effort to provide for his family. 
In that event, both husband and wife may apply. Their 
joint applications indicate a mutual desire for the protec- 



28 

tion of the minor members of the family, and are regarded 
as such. 

An unmarried woman may obtain a policy as an invest- 
ment, or, in other words, an Endowment or Limited Pay- 
ment Life Policy, the benefits from which may prove ser- 
viceable in future years. 

From the foregoing remarks we have a foundation for 
the following conclusions : 

First. There is a moral hazard in certain cases. 
. Second. It may be present or prospective. 

Third. It may exclude a risk otherwise acceptable. 

Fourth. The following rules should govern the Agent in 
selecting and the Medical Examiner in recommending risks 
for acceptance in the Ordinary Branch : 

Rule A. There should be no suspicion of speculation. 

Rule B. The amount of insurance should be commen- 
surate with the means of the applicant. 

Rule C. The occupation should be free of pernicious 
influences. 

Rule D. It is very desirable (not essential) that an 
applicant shall show that he has had permanent employ- 
ment and a home of his own. 

Rule E. The applicant should be suflQciently educated 
to read the terms of his contract with the Company, and to 
write his name. 

Rule F. Applications on the lives of married women 
should not be written unless their husbands also apply. 

Rule G. Whole Life applications on the lives of unmar- 
ried women or widows should not be written unless they 
have dependent directly upon them minor children or 
parents who are not self-supporting. Applications for 
Endowments or Limited Payment Life Policies are prefer- 
able in unmarried women. 






Medical Department. 



;-^^^^.;^v--^' 



^mm 



Ii|siirai|ef ^fliptw^^ 



Q F' oVC>a:i'l'R:( V>JK, 



■ i^/;. Medical Examinations ^ /V^///^y'^^y|:lf January 5th, /^^7. 
and Medical Inspections. ' ^ 



Dear Doctor: 

After January 18th nextj all adults (ten 
years next birthday and over) will be examined when the aggre- 
gate amount of insurance applied for reaches or exceeds $250. 

When the aggregate amount is less than $250 a medical inspec- 
tion must be made. 

A medical inspection is satisfactory when the following condi- 
tions are fulfilled: 

1. You should personally see the applicant, giving the date on 
which you saw him or her. 

2. You should give as near as you can his correct age next 
birthday, regardless of any statement made on the application. 

3. You should state to the best of your judgment his present 
condition of healtn. 

4. You should ascertain if he or she has signed the applica- 
tion and paid the premium. 

5. You should secure the applicant's signature on the inspec- 
tion report only. Do not secure the signature for the Agent. 

6. You should sign your own name. 

Remember that v;henever you are requested to make an ex- 
amination, an inspection will not answer. There is a decided 
difference between an inspection and an examination. In an 
inspection, judgment is given from the appearance of the indi- 
vidual as well as from answers to inquiries that may be made. In 
an examination the party is not only asked certain questions, 
but the Examimer is expected to ascertain by percussion and aus- 
cultation the condition of the heart, lungs and abdominal viscera. 
The fee for a medical inspection has been fixed at Twenty-five 
cents. No fee will be paid unless the applicant is seen. 

Should you see an applicant and be unable to procure his or 
her signature, you should state that the party refuses to sign 
your report and that he or she has or has not signed the appli- 
cation. In addition to this you should state the apparent condi- 
tion of health, the age next birthday and such other facts as 
may be called for on the inspection form. In such cases the fee 
will be paid. 

The fee for medical examinations will remain as heretofore. 
Will you undertake these inspections? A prompt reply will oblige, 
Very truly yours. 



&x, 



Medical Director. 



Medical Department. 

^1^1]? fiijcl^f|il?iJ Jr[siij'ci4(^p ^f£)fflp£iW^ 



Ci) i''.v\ivr.f<;]R ( (u\ , 



/. 






Dear Doctor: — 

We send you by this mail a Manual of Instructions 
to Examiners for the Ordinary Branch, and take this occasion to 
request that you will read it carefully. 

There are a few matters, for certain reasons, not incorporated 
in the book, to which we wish to call your attention. 

You will readily understand how desirable it is that you 
should be on cordial terms with the members of the Field Staff; 
that you should visit the office of the Agency at such times as 
the necessities of the business may require, and, so far as it is 
possible, work in harmony with them. 

You should never hesitate to communicate confidentially with 
the Medical Department concerning any matter that you may deem of 
importance or interest to the Company, feeling assured that your 
confidence will be respected. 

You are not under obligation, because of your position as 
Medical Examiner, to attend in your professional capacity members 
of the Field Staff, or their families, without charging and 
receiving your usual compensation. It is particularly desirable 
that you should not have any business transaction with the members 
of the Agency Staff. The loaning or borrowing of money should be 
strictly avoided, as we would of necessity be compelled to regard 
as undesirable the services of an Examiner who permitted an Agent 
to be under any pecuniary obligation to him, or allowed himself to 
be under such obligation to an Agent. 

Finally, bear in mind that we look for all the facts relative to 
an applicant, and for your individual opinion of every person examined, 
regardless of suggestions which may be offered to you by any one. 

By observing the instructions received from the Medical Depart- 
ment, and disregarding anything that may be offered by others 
concerning the selection of risks, you will, we trust, do your part 
toward placing our medical service on the plane which it should 
occupy, and maintain long and pleasant relations with The Prudential. 

Please acknowledge the receipt of this le t ter and the Book of 
Instructions. 

Very truly yours. 



Med. Director. 



Medical Department. 

'Tile f-riJcl^TiiiEi] Jii>jiir£ific-^e f miipsuivr^ 

. i^/. Bicycle Riders ' h//y///\. // Jul. 3, / )// ^ . 

P. 11. Putnam, M.D., 

Binchamton, N: Y. I 

Dear Doctor:- 

In reply to your enquiry of the 1st we would sa • 
that the professional rider is eligible for insurance. It is barely 
possible that an extra premium might be imposed If the occupation 
is that of a professional rider solely. We are not certain 
as to the imposition of an extra premium, and our reply to you 
on this point is made with some doubt ir. our own minds. At any 
rate the party is eligible for any kind of insurance he may desire, 
with or without an extra premium. 

Very truly yours, 

Med. Director. 



'^ZA ^^ 



Reply. 



Dear Doctor;- 

Your le ' 
I hereby accept the . 
Company^ after havin 
Examiners, and promi * 
for my guidance. W 



*BE ba received and ree 




'Ike fiM^^i^immm^^tfffs^^^ 



Dear Doctor: — 

We send you by this mail a Manual of Instructions 
to Examiners for the Ordinary Branch, and take this occasion to 
request that you will read it carefully. 

There are a few matters, for certain reasons, not incorporated 
in the book, to which we wish to call your attention. 

You will readily understand how desirable it is that you 
should be on cordial terms with the members of the Field Staff; 
that you should visit the office of the Agency at such times as 
the necessities of the business may require, and, so far as it is 
possible, work in harmony with them. 

You should never hesitate to communicate confidentially with 
the Medical Department concerning any matter that you may deem of 
importance or interest to the Company, feeling assured that your 
confidence will be-respected. 

You are not under obligation, because of your position as 
Medical Examiner, to attend in your professional capacity members 
of the Field Staff, or their families, without charging and 
receiving your usual compensation. It is particularly desirable 
that you should not have any business transaction with the members 
of the Agency Staff. The loaning or borrowing of money should be 
strictly avoided, as we would of necessity be compelled to regard 
as undesirable the services of an Examiner who permitted an Agent 
to be under any pecuniary obligation to him, or allowed himself to 
be under such obligation to an Agent. 

Finally, bear in mind that we look for all the facts relative to 
an applicant, and for your individual opinion of every person examined, 
regardless of suggestions which may be offered to you by any one. 

By observing the instructions received from the Medical Depart- 
ment, and disregarding anything that may be offered by others 
concerning the selection of risks, you will, we trust, do your part 
toward placing our medical service on the plane which it should 
occupy, and maintain long and pleasant relations with The Prudential. 

Please acknowledge the receipt of this let ter and the Book of 
Instructions . 

Very truly yours. 



Med. Director. 



Reply, 



La 



>n 



Dear Doctorl- 

Your le 
I hereby accept the . 
Company^ after havin 
Examiners^ and promi 
for my guidance. 

*BB fesa receivrcd and r?- 



Reply. 



Dear Doctor:- 

Your letter of the inst. r<!oeived. 

I hereby accept the appointment as Medical Examiner for your 
Company, after having carefully read your instructions to 
Examiners, and promise to observe all the rules laid down 
for my guidance. 



n ttw jr^n .?.. nnrtrwtian book 
*B£ fea recfi.r •■ and real 



©vbiuar^ Branch* 



J'J^AfjY OF CONGRESS 

021 048 000 6 



